In January 2017, President Donald J. Trump announced a series of Executive Orders that provide the Department with additional resources, tools, and personnel to carry out the critical work of securing our borders, enforcing our immigration laws, and ensuring that individuals who pose a threat to national security or public safety cannot enter or remain in our country. Protecting the American people is the highest priority of our government and this Department.
Is Continuity of Operations (COOP) the same as an ordinary emergency plan? If not, how are they different?
hypothalamic function, the appearance of sleep-wake cycles, and the absence of the awareness of self or the environment (Giacino et al., 2013). Patients in a vegetative state are also unable to respond purposefully to noxious stimuli, express or understand language. However, they may have cranial nerve and spinal reflexes, such as swallowing, blinking, and knee-jerk reflexes (Shea et al., 2013; Laureys et al., 2002). The vegetative state is usually the consequence of a coma that lasts for longer than a month and can be categorized into either a persistent vegetative state, or permanent vegetative state. A coma due to a traumatic brain injury that persists for over 12 months or a coma due to a non-traumatic brain injury that persists for over 3 months is considered a permanent vegetative state. A coma that lasts more than a month is considered a persistent vegetative state (Georgiopoulos et al., 2010). Patients in a permanent vegetative state are less likely to recover compared to those in a persistent vegetative state. During wake cycles, the eyes open and move but do not fixate on a particular target and the limbs may move meaninglessly. Painful and noxious stimuli can elicit reflexes and physiological progresses such as eye opening, increase in respiratory rate, heart rate, and blood pressure (Laureys et al., 2002). The preservation of pupillary, corneal, oculocephalic, and gag reflexes also allow vegetative patients to display spontaneous movements such as chewing, teeth-grinding, swallowing, moaning, and smiling (Laureys et al., 2002). Compared to healthy individuals, the resting brain metabolism of patients in a vegetative state is 50-60% lower (Laureys et al., 2002). PET studies and mapping analysis have revealed that the brain regions associated with metabolic impairment are the prefrontal, premotor, and parietal-temporal cortices, and the posterior cingulate region (Laureys et al., 2002). These cortices are involved in attention, working memory, episodic memory, language, and conscious perception while the posterior cingulate region is involved in conscious waking (Laureys et al., 2002). Conversely, the metabolism of the brain stem, basal forebrain, and posterior hypothalamus are relatively preserved (Laureys et al., 2002). These regions play a crucial role in sleep-wake cycles, autonomic control, and cranial nerve reflexes that are observed in patients in a vegetative state (Laureys et al., 2002). The minimally conscious state is distinguished from the vegetative state by the presence of inconsistent behavioral evidence of consciousness and partial awareness (Giacino et al., 2013). Patients in minimally conscious states are characterized by sleep/wake cycles and purposeful movements. They are able to maintain visual fixations, localize auditory stimuli, verbalize and gesture, follow commands, and may give emotional responses (Davis, 2007). However, a patient’s health and cognitive abilities can influence their motor, visual, and auditory abilities, as these abilities may deteriorate in patients with poor health or reduced cognition. Although few brain imaging studies have been done on patients in the minimally conscious state, it has been revealed that the cingulate cortex and parietal cortex remain functional (Davis, 2007). This suggests that the neurological networks that are involved in consciousness retain their functionality. Despite current knowledge concerning these states of consciousness, questions still arise about how these states of consciousness emerge and are maintained biologically. This review will investigate both the vegetative and minimally conscious states by considering biological and neurological pathways that can result in either states of consciousness and current advancements that aim to treat these conditions.>GET ANSWER